Case 5 Flashcards
The Canadian Head Trauma CT Rule is not applicable if
- Non-traumatic cause
- GCS <13
- Age <16 years old
- Coumadin or bleeding disorder
- Obvious open skull fracture
Glasgow Camo Scale
- Motor response: 6 - obeys commands fully; 5 - localizes to noxious stimuli; 4 - withdraws from noxious stimuli; 3 - abnormal flexion (decorticate); 2 - extensor response (decerebrate); 1 - no response
- Verbal response: 5 - alert & oriented; 4 - confused yet coherent; 3 - inappropriate words; 2 - incomprehensible sounds; 1 - no sounds
- Eye opening: 4 - spontaneous eye opening; 3 - eyes open to speech; 2 - eyes open to pain; 1 - no eye opening
Glasgow Coma Scale Scorring
- Mild: 13-15
- Moderate Disability (9-12): LOC >30 min, benefit from rehab
- Severer disability (3-8): coma
- Vegetative state (<3): sleep wake cycle, arousal, no localized response to pain
What are the DAN’s
- 5 D’s: dizziness, diplopia, drop attacks, dysarthria (hoarseness/hiccups), dysphagia
- 2 A’s: ataxia of gait and anxiety
- 3 N’s: nausea, numbness (ipsi face or contra body), nystagmus
What cranial nerves are most affected with acute internal carotid dissection
- Hypoglossal nerve (CN XII)
- Glossopharangeal nerve (CN IX)
- Vagus nerve (CN X) or Accessory Nerve (CN XI)
- Horner’s Syndrome
What 3 dysfunctional make up Horner’s Sydnrome
- Ptosis: drooping eyelid
- Miosis: pupil constriction
- Anhydris of the face: dryness
CPR for cervical myelopathy
- Gait deviation
- Hoffman’s sign
- Inverted supinator sign
- Babinski sign
- Age >45 years old
- Pos for 3+ is 99% SP
What does SINSS stand forr
- Severity
- Irritability
- Nature
- Stage
- Stability
Risk factors for WAD (whiplash associated dysfunction)/coordination impairment
- High pain intensity
- High self-reported disability scores (NDI)
- High post-traumatic stress symptoms
- Strong catastrophic beliefs
- Cold hyperalgesia
What tests would be positive for neck pain with movement coordination impairments (WAD)
- Cranial cervical flexion test
- Neck flexor endurance test
- Pressure algometry
Describe the grades for the Quebec Task Force Original Classification
- Grade 0: no complaint about neck pain & no physical signs
- Grade 1: neck complaint of pain, stiffness, or tenderness only; no physical signs
- Grade 2: neck complaint, MSK signs
- Grade 3: neck complaint, MSK signs/neurological signs (decreased DTRs, muscle/sensory deficits)
- Grade 4: neck complaint & fracture or dislocation
What tests are positive for neck pain with headache
- Cervical flexion rotation test
Describe the cervical flexion rotation test (CFRT)
- Tests rotation of upper C1-2
- Supine: flex C-spine passively to end range then rotate L/R
- Compare rotation L/R: 10º difference b/w sides or less than 32º is positive
Describe the cervical rotation lateral flexion test (Lindgren’s test)
- Tests lower C-spine
- Proposed to test 1st rib mobility at C7
- Sitting rotate head away then laterally flex towards
- Pos = unable to laterally flex or large differences with contralateral side
CT head is only required for minor head injury patients with any one of these findings (Canadian CT Head Rule)
- GCS <15 at 2hrs after injury
- Suspected open or depressed skull fracture
- Any sign of basal skull fracture
- Vomiting ≥2 episodes
- Age ≥65 years old
- Medium risk: Amnesia before impact ≥30min and dangerous mechanism (pedestrian occupant ejected, fall from elevation)
